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      Implementación de un programa de estimulación cognitiva en personas con demencia tipo Alzheimer: un estudio piloto en chilenos de la tercera edad Translated title: Implementation of a Cognitive Stimulation Program for People with Alzheimer Disease: A Pilot Study in a Chilean Elderly Sample

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          Abstract

          La Terapia de Estimulación Cognitiva (TEC) es una intervención psicosocial para personas con demencia que ha obtenido buenos resultados en población anglosajona. El objetivo de este estudio fue evaluar la eficacia de la TEC en una muestra de personas chilenas. Participaron 22 pacientes con diagnóstico de Enfermedad de Alzheimer (EA) en fase leve a moderada, pertenecientes a un centro asistencial de la ciudad de Quillota, Chile. Para determinar la eficacia del programa, se definió un diseño experimental mixto 2x2 de medidas repetidas, asignándose aleatoriamente la muestra a dos grupos: intervención (GI) y control (GC). Se establecieron tres dimensiones para evaluar: cognición, calidad de vida y capacidad funcional de la persona con demencia. Posterior a la intervención, el GI presentó una mejoría significativa en sus indicadores de deterioro cognitivo y calidad de vida; por el contrario, el GC no evidenció cambios positivos en ninguna dimensión, empeorando el declive cognitivo. Ninguno de los grupos experimentó cambios significativos en la capacidad funcional. Si bien en la comparación intergrupo no existieron diferencias significativas en ninguna variable, el GI presentó una mejoría sustancial de la función cognitiva, en comparación con el aumento en la progresión del deterioro cognitivo en el GC. Se recomienda que futuras investigaciones contrasten dichos resultados utilizando una muestra más grande de personas con EA.

          Translated abstract

          Cognitive Stimulation Therapy (CST) is a psychosocial intervention for people with dementia that has been successful in Anglo-Saxon population. The aim of this study was to assess the effectiveness of CST in a sample of Chilean elders. The participants were 22 patients diagnosed with Alzheimer's disease (AD) in mild to moderate stage, who were living in a residential care home in the town of Quillota, Chile. In order to determine the effectiveness of the program, an experimental mixed design 2x2 (repeated measures) was employed. The sample was randomly assigned into two groups: intervention group (IG) and control group (CG). Three dimensions were assessed: cognition, quality of life and functional ability. After the intervention, the IG presented a significant improvement in their cognitive function and quality life. In contrast, the CG did not show positive changes in any dimension. In fact, CG showed a worsening in its cognitive deterioration. Both groups did not showed significant changes in functional ability. Even though intergroup comparisons did not yield significant differences, the IG showed an important improvement in cognitive function, compared with an increase in the progression of cognitive impairment in the CG. It is recommended that future research will contrast these results using a larger sample of people with AD.

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          Most cited references69

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          Diagnostic and statistical manual of mental disorders.

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            Contribution of chronic diseases to disability in elderly people in countries with low and middle incomes: a 10/66 Dementia Research Group population-based survey

            Summary Background Disability in elderly people in countries with low and middle incomes is little studied; according to Global Burden of Disease estimates, visual impairment is the leading contributor to years lived with disability in this population. We aimed to assess the contribution of physical, mental, and cognitive chronic diseases to disability, and the extent to which sociodemographic and health characteristics account for geographical variation in disability. Methods We undertook cross-sectional surveys of residents aged older than 65 years (n=15 022) in 11 sites in seven countries with low and middle incomes (China, India, Cuba, Dominican Republic, Venezuela, Mexico, and Peru). Disability was assessed with the 12-item WHO disability assessment schedule 2.0. Dementia, depression, hypertension, and chronic obstructive pulmonary disease were ascertained by clinical assessment; diabetes, stroke, and heart disease by self-reported diagnosis; and sensory, gastrointestinal, skin, limb, and arthritic disorders by self-reported impairment. Independent contributions to disability scores were assessed by zero-inflated negative binomial regression and Poisson regression to generate population-attributable prevalence fractions (PAPF). Findings In regions other than rural India and Venezuela, dementia made the largest contribution to disability (median PAPF 25·1% [IQR 19·2–43·6]). Other substantial contributors were stroke (11·4% [1·8–21·4]), limb impairment (10·5% [5·7–33·8]), arthritis (9·9% [3·2–34·8]), depression (8·3% [0·5–23·0]), eyesight problems (6·8% [1·7–17·6]), and gastrointestinal impairments (6·5% [0·3–23·1]). Associations with chronic diseases accounted for around two-thirds of prevalent disability. When zero inflation was taken into account, between-site differences in disability scores were largely attributable to compositional differences in health and sociodemographic characteristics. Interpretation On the basis of empirical research, dementia, not blindness, is overwhelmingly the most important independent contributor to disability for elderly people in countries with low and middle incomes. Chronic diseases of the brain and mind deserve increased prioritisation. Besides disability, they lead to dependency and present stressful, complex, long-term challenges to carers. Societal costs are enormous. Funding Wellcome Trust; WHO; US Alzheimer's Association; Fondo Nacional de Ciencia Y Tecnologia, Consejo de Desarrollo Cientifico Y Humanistico, Universidad Central de Venezuela.
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              Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia: randomised controlled trial.

              A recent Cochrane review of reality orientation therapy identified the need for large, well-designed, multi-centre trials. To test the hypothesis that cognitive stimulation therapy (CST) for older people with dementia would benefit cognition and quality of life. A single-blind, multi-centre, randomised controlled trial recruited 201 older people with dementia. The main outcome measures were change in cognitive function and quality of life. An intention-to-treat analysis used analysis of covariance to control for potential variability in baseline measures. One hundred and fifteen people were randomised within centres to the intervention group and 86 to the control group. At follow-up the intervention group had significantly improved relative to the control group on the Mini-Mental State Examination (P=0.044), the Alzheimer's Disease Assessment Scale - Cognition (ADAS-Cog) (P=0.014) and Quality of Life - Alzheimer's Disease scales (P=0.028). Using criteria of 4 points or more improvement on the ADAS-Cog the number needed to treat was 6 for the intervention group. The results compare favourably with trials of drugs for dementia. CST groups may have worthwhile benefits for many people with dementia.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rups
                Universitas Psychologica
                Univ. Psychol.
                Pontificia Universidad Javeriana (Bogotá )
                1657-9267
                April 2013
                : 12
                : 2
                : 445-455
                Affiliations
                [1 ] Universidad de Valparaíso
                [2 ] Universidad de Chile
                [3 ] Universidad de Valparaíso
                [4 ] Universidad de Valparaíso
                [5 ] Universidad de Valparaíso
                Article
                S1657-92672013000200012
                10.11144/Javeriana.UPSY12-2.ipec
                d506bfbe-011b-4296-9b1f-6d93bea499fa

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Colombia

                Self URI (journal page): http://www.scielo.org.co/scielo.php?script=sci_serial&pid=1657-9267&lng=en
                Categories
                PSYCHOLOGY, MULTIDISCIPLINARY

                Clinical Psychology & Psychiatry
                Dementia,Alzheimer's Disease,Cognitive Stimulation,Latin America,Elderly,Pilot Study,Chile,Demencia,enfermedad de Alzheimer,estimulación cognitiva,Latinoamérica,Anciano,estudio piloto

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